The main New York workers’ compensation forms each serve a specific procedural function. The Form C-3 is the employee’s claim, which must be filed within 30 days of injury. The C-4 series (C-4 initial, C-4.2 progress, C-4.3 permanency) carries medical reporting from your treating physician. The FROI-04 is the employer’s First Report of Injury, due within 10 days of knowledge. The SROI-04 family is filed by the carrier whenever indemnity payments begin, change, or stop. The RFA-1 lets the claimant request a hearing; the RFA-2 is the employer/carrier equivalent. The C-240 is the wage statement that determines your Average Weekly Wage — and the indemnity rate that flows from it.
C-3, C-4, FROI, SROI, RFA, C-240 — here’s what each one does and when it matters.
TL;DR
- C-3 — the worker’s employee claim. Must file within 30 days of injury.
- C-4 series — medical reports from treating providers. C-4 (initial), C-4.2 (progress), C-4.3 (permanency).
- FROI-04 — employer’s first report of injury.
- SROI-04 — carrier’s subsequent reports, including indemnity payment information.
- RFA-1 — Request for Further Action (claimant) or RFA-2 (employer/carrier). Used to request hearings.
- C-240 — wage statement. Determines AWW.
The forms that matter most
C-3 — Employee Claim
You file this. Within 30 days of injury. It tells the WCB and the carrier you are claiming a work injury.
What goes wrong: filed late (still claimable but a defense gets raised); incomplete; missing all wage components.
C-4 series — Medical Reports
Filed by your treating physician.
- C-4 — initial visit report
- C-4.2 — progress report (typically every 90 days for ongoing treatment)
- C-4.3 — permanency / MMI evaluation
- C-4 Auth — pre-authorization request for treatment
What goes wrong: treating physician doesn’t file timely; doesn’t document causation language clearly; MMI evaluation premature.
FROI-04 — First Report of Injury (employer)
Employer/carrier files within 10 days of knowledge.
What goes wrong: filed late; characterizes the injury narrowly; misses date or mechanism.
SROI-04 series — Subsequent Reports
Carrier files when indemnity payments start, stop, or change rate. Each version (1, 2, 3 etc.) marks a status change.
What goes wrong: wrong AWW; wrong indemnity rate; payments stopped without basis.
RFA series — Request for Further Action
- RFA-1 — claimant requests a hearing
- RFA-2 — employer/carrier requests a hearing
What goes wrong: RFA needed but not filed; case stalls in administrative limbo until requested.
C-240 — Wage Statement
Determines your Average Weekly Wage, which sets your indemnity rate. AWW is the heart of the money.
What goes wrong: filed with incomplete payroll; misses overtime, holiday pay, differential, mutual swaps; uses wrong look-back period; doesn’t include similar-employee comparison when needed.
Other forms
- HP-1 — physician’s request for pre-authorization
- MG-1, MG-2 — variance request and response
- C-32 / C-32.1 — Section 32 settlement agreement and notice
- C-25 — annual report of injury status for ongoing classified cases
- C-67 — proof of coverage notice
- C-258 — health insurance lien notice
- C-2F — modified C-3 for occupational disease claims
Where to find them
All NY WC forms are at the WCB website’s forms section. Many are filed electronically through the WCB’s eCase / OnBoard system rather than paper.
What to do next
The forms are downloadable but the strategy of when and what to file matters. Contact me directly.
Related pages
- How is my Average Weekly Wage calculated?
- What happens at a workers’ comp hearing?
- What is an IME and can I refuse one?
- How long does a NY workers’ comp case take?
Frequently Asked Questions
What are the main New York workers' compensation forms?
The key NY workers' comp forms are: C-3 (employee claim, filed within 30 days), C-4 series (medical reports), FROI-04 (employer's first report), SROI-04 (carrier's subsequent reports), RFA-1 (claimant hearing request), and C-240 (wage statement determining AWW).
This page is informational. It is not legal advice and does not create an attorney-client relationship. Every workers' compensation case turns on its facts. For analysis of your matter, contact me directly.